tbuckley/cabot-search huggingface dataset:
AB1220 CHARACTERISTICS OF INFECTIOUS SPONDYLODISCITIS IN ELDERLY
Authors: I. Mahmoud, M. Aouini, A. Ben Tekaya, S. Bouden, R. Leila, R. Tekaya, O. Saidane, L. Abdelmoula
Journal: Annals of the Rheumatic Diseases (2022)

Background Infectious spondylodiscitis is a rare but growing disease. It is a serious infection that can compromise both the functional and vital prognosis especially on elderly subjects. Objectives The purpose of this study was to compare the clinical, bacteriological and evolutionary characteristics of elderly patients admitted for management of infectious spondylodiscitis with a case-control group of young subjects. Methods Retrospective, descriptive study carried out in the rheumatology department of the Charles Nicolle Hospital from 2010 to 2019. Adult patients hospitalized for infectious spondylodiscitis were included. Clinical, bacteriological and evolutionary data were analysed and comparing those over 65 years of age with young case-control subjects. Results Of the 78 patients included, 33 patients belonged to the elderly group and 45 to the control group. The duration of evolution was shorter for the control group (123 vs. 181 months for the elderly; p=0,71). The progressive mode of onset characterised the elderly group (P&lt;0.05). Spinal pain was constant. Neurological abnormalities, night sweats, and altered general condition were more present in the elderly (p&lt;0.05). Spinal stiffness was more present in the control group (p&lt;0.05). There was no difference between the two groups in terms of the presence of fever and radiculalgia. Spinal biopsy was performed in 72% of the elderly subjects and in 80% of the control group. The most common germ in the elderly group was tuberculosis and brucellosis in the control group (p&lt;0.05). A favorable evolution was noted in 75% of the cases in the control group compared to 66% of the elderly subjects (p&lt;0.05). Neurological complications and mortality were more common in the elderly (p&lt;0.05). Conclusion Infectious spondylodiscitis on elderly is characterised by an insidious onset, a confusing clinical picture and a more severe presentation than young people with significant complications and mortality. Disclosure of Interests None declared
AB1459 IMPACT OF SOCIOECONOMIC FACTORS ON THE DISEASE ACTIVITY: DATA FROM THE TUNISIAN BINAR REGISTRY
Authors: R. Ben Aissa, S. Boussaid, S. Rekik, S. Jemmali, S. Rahmouni, H. Srairi Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite the considerable therapeutic progress of inflammatory rheumatic diseases, access to treatment still challenging in developing countries because of scarce health resources and low socioeconomic status. Objectives To determine the influence of socioeconomic factors on disease activity in a national registry cohort, the Biological National Registry (BINAR) in Tunisia. Methods We enrolled patients with inflammatory rheumatic diseases under the first received biological drug and included in the BINAR registry from 2016 to 2020. Data on the inflammatory rheumatic disease (rheumatoid arthritis (RA) and spondyloarthritis (SA)), disease activity of RA and SA (DAS28-CRP and ASDAS-CRP respectively) at baseline, gender, active smoking, marital and work status and educational attainment were collected. Two groups were identified: Groupe 1 (G1) for patients with remission or low disease activity and groupe 2 (G2) for moderate or high disease activity according to DAS28-CRP and ASDAS-CRP. Results The study included 298 patients with a mean age of 49.2 years [18-79]. The mean disease duration was 6.7 ± 3.5 years [1-14] in patients with RA and 6.5 ±3.6 years [1-12] in patients with SA. G1 was made of 13 patients and G2 of 285 patients. The were no significant difference between G1 and G2 for (49.5 ± 11.9 versus 49.5±14.2, p=0.93) gender (% of females, 46.2% versus 37.1%, p=0.51) and marital status (% of single patients, 30.8 % versus 33.7%,p=0.82). Patients of G1 had better employability than G2 (61.5% % versus 45.6%) but this difference was not significant (p=0.26). Smoker patients had better disease outcomes comparing to nonsmokers but this difference was not significant (23.1 % versus 13.7%, p=0.34). Illiterate patients had more active diseases, comparing to literate, but this difference was not significant (30.8% versus 40.4%, p=0.49). Conclusion Our results did not confirm any difference in disease activity according to the collected socioeconomic factors. Data on the personal income, health insurance type and geographic distribution of our population should be further studied. Disclosure of Interests None declared
AB1058 IS HYPERURICEMIA ASSOCIATED WITH TYPE 2 DIABETES DEGENERATIVE COMPLICATIONS?
Authors: F. Fhima, N. El Amri, D. Khalifa, A. Ben Abdelkrim, B. Ben Abdallah, S. Lataoui, K. Baccouche, E. Bouajina, K. Ach
Journal: Annals of the Rheumatic Diseases (2022)

Background Prevalence of hyperuricemia (HU) is constantly increasing around the world and HU is now identified as an independant cardiovascular risk factor. Objectives To determine the prevalence of HU in patients with type 2 diabetes (T2D) and to identify degenerative complications of T2D associated with HU. Methods A cross-sectional descriptive study was conducted in the rheumatology and endocrinology departments of Farhat Hached University Hospital of Tunisia over a period of 6 months. Patients diagnosed with T2D according to the 2021 guidelines of the American Diabetes Association were included. A cut-off of uric acid ≥ 360 µmol/L in females and ≥ 420 µmol/L in males was used to define HU. Results One hundred fifty-one patients were included. Sex ratio F/M was 1.4. The median of age was 61 years. The prevalence of HU was 17.2%. Only 6 % of patients had gout. Degenerative complications of T2D were encountered in 74.2% of cases. Diabetic neuropathy was the most common (51.7%) and was significantly associated with HU (p=0.049). Diabetic nephropathy was reported in 38.4% of patients and was also associated with HU (p= 0.008). HU was associated with renal failure (p &lt; 0.01), microalbuminuria (&lt;0.01), proteinuria (p=0.001) and history of ischemic stroke (p=0.048). Diabetic feet problems were reported in 15.9 % of patients and were associated with HU (p=0.008). Nevertheless, diabetic retinopathy (39.7%), peripheral arteriopathy of lower limbs (27.2%) and myocardiopathy (15.2%) were not associated with HU. Conclusion HU is common in patients with T2D. Our study raises the question whether HU could be a risk factor for the development of degenerative complications in T2D patients. Screening for HU could be recommended in T2D patients for a holistic assessment of the disease. References [1]Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008: Prevalence of Gout and Hyperuricemia in the US. Arthritis Rheum. oct 2011;63(10):3136-41. [2]Xiong Q, Liu J, Xu Y. Effects of Uric Acid on Diabetes Mellitus and Its Chronic Complications. Int J Endocrinol. 13 oct 2019;2019:1-8. Disclosure of Interests None declared
AB1035 END STAGE RENAL DISEASE IN PATIENTS WITH GOUT AND CONTROLS, ETIOLOGICAL DIFFERENCES?
Authors: L. Höper, U. Lindström, H. Herlitz, M. Dehlin
Journal: Annals of the Rheumatic Diseases (2022)

Background The association between gout and renal disease is well known. However, whether hyperuricemia causes renal disease, or if the association is explained by comorbidities, is still up for debate. Studies on the effects of urate and gout on chronic kidney disease (CKD) show conflicting results. There is a lack of data on the underlying causes of CKD in gout patients. Objectives To compare causes of end stage renal disease (ESRD) in patients with gout and population controls. Methods This is a population-based and register-based case-control study. Gout cases, aged 18 years or older, were identified by at least one visit to a physician either an in- or outpatient clinic with a registered ICD-10 code for gout (M10) in the Western Regional Healthcare Contact Register (VEGA), between January 1st 2001 through December 31st 2018. For each case five controls without gout were matched by sex, age, and county/place of residence at year of first diagnosis. Cases and controls were excluded if they prior to the first recorded ICD-10 code for gout, had a record of end stage renal disease, defined as codes for renal transplantation or dialysis either in VEGA or the Swedish Kidney Register (SNR). In this cohort, all cases and controls developing ESRD during the follow-up period (2001 to 2018) were identified, and the registered causes of ESRD were compared across the groups. Results In total, 48594 gout cases (mean age 68.4 years; 67% male), and their 150618 matched controls (mean age 63.3 years; 67% male) were included. Of the cases and controls, 529 (1.1%) and 128 (0.1%) developed ESRD, respectively. At the time-point of active uremia treatment start (as in start of dialysis or kidney transplantation), the cardiovascular comorbidity burden was higher for the gout patients (Table 1). There was no significant difference in the distribution of ESRD-causes between patients with gout and their controls (Figure 1). Table 1. Baseline data Gout Controls Number (% of total) 529 (80.5) 128 (19.5) Age at gout diagnosis, mean (median) 64.2 (65) 63.3 (65) Age at ESRD, mean (median) 69.2 (72) 68.9 (71) Male sex, n (%) 389 (73.5) 109 (85.2) No renal failure at baseline, n (%) 239 (44.6) 77 (60.2) Diabetes, n (%) 215 (40.6) 44 (34.4) Hypertension, n (%) 473 (89.4) 110 (85.9) Ischemic heart disease, n (%)* 206 (38.9) 26 (20.3) Cerebrovascular disease, n (%) 89 (16.8) 15 (11.7) Hematologic malignancy, n (%) 11 (2.1) 6 (4.7) Dermatologic malignancy, n (%) 12 (2.3) 3 (2.3) Other malignancy, n (%) 65 (12.3) 16 (12.5) *p&lt;0,001 Figure 1. Conclusion In this study, including 48594 cases with gout, of which 529 developed ESRD, there was no apparent difference in the cause of ESRD compared to matched controls. This suggests similar pathophysiological mechanisms of ESRD development in patients with gout and the general population. Disclosure of Interests None declared
Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions
Authors: Eirik Joakim Tranvåg, Øystein Ariansen Haaland, Bjarne Robberstad, Ole Frithjof Norheim
Journal: JAMA Network Open (2022)

Rising health care costs are a major health policy challenge globally. Norway has implemented a priority-setting system intended to balance cost-effectiveness and concerns for fair distribution, but little is known about this strategy and whether it works in practice.To present and evaluate a systematic drug appraisal method that uses the severity of disease to account for a fair distribution of health in cost-effectiveness analysis, forming the basis for price negotiations and coverage decisions.This cross-sectional study uses confidential drug price information and publicly available data from health technology assessments and logistic and linear regression analyses to evaluate drug coverage decisions for the Norwegian specialized health care sector from 2014 to 2019.Drug coverage decisions by Norwegian authorities and incremental cost-effectiveness and severity of disease measured as absolute shortfall of quality adjusted life years.Between 2014 and 2019, a total of 188 drugs were appraised, of which 113 were cancer drugs. The overall coverage rate was 73% (138 of 188). The number of annual appraisals increased during the observation period. Based on 83 chosen decisions, regression analysis showed that incremental cost-effectiveness ratios (ICER) based on negotiated drug prices, adjusted for severity-differentiated cost-effectiveness thresholds, was the variable that best projected drug approvals (OR, 0.60; 95% CI, 0.42-0.86). An increase in the ICER by $10 000 was associated with a reduction in the odds for approval of 40% for drugs assessed from 2018 to 2019.This cross-sectional study demonstrated how concerns for efficiency and fair distribution of health can be implemented systematically into drug appraisals and reimbursement decisions. New, expensive drugs are expected to escalate health care costs in the years to come, and it may be feasible to control costs by negotiating the prices of new drugs while appraising both their cost-effectiveness and how their health benefits are distributed.
AB0246 EXAMINATION OF THE FACTORS CONSTITUTING DEPRESSIVE STATE IN RHEUMATOID ARTHRITIS PATIENTS AND THEIR ASSOCIATIONS.
Authors: Y. Miwa, Y. Mitamura, M. Hosaka
Journal: Annals of the Rheumatic Diseases (2022)

Background About 15% of patients with rheumatoid arthritis (RA) have depression, with an odds ratio of 1.42 (95% CI: 1.3-1.5) compared with healthy control. In previous reports, depressed mood and sleep disorders were reported separately, and no report has examined the factors that constitute depression. In addition, there is no report that examines the relationship between them. Objectives In the present study, we investigated the factors that constitute depression in RA patients. Methods One hundred and twenty-four patients with RA attending Showa University Hospital who gave written consent to the study were included in the study. Age, gender, body mass index, smoking history, presence of hypertension, presence of diabetes, steroid use, methotrexate use, erythrocyte sedimentation rate, CRP, and serum MMP-3 levels were investigated. The simplified disease activity index (SDAI) was used to assess disease activity in RA, the health assessment questionnaire disability index (HAQ-DI) was used to assess activity of daily living, and the Hamilton depression rating scale (HAM-D) was used to assess depression. All patients were interviewed for the HAM-D by the same interviewer, and the relationship between each item of the HAM-D and each index was examined. Results Forty-two patients (33.9%) reported experiencing “Depressed mood”. On the other hand, a higher percentage of patients reported “Anxiety Somatic (79, 63.7%),” “ Somatic Symptoms General (69, 55.6%),” “Work and Activities (57, 46.0%),” “Hypochondriasis (53, 42.7%),” and “Genital Symptoms (49, 36.5%)” than depressed mood. Depressed mood” was correlated with SDAI (r=0.31) and HAQ-DI (r=0.26), while “ Somatic Symptoms General “ was correlated with SDAI (r=0.30) and HAQ-DI (r=0.29). “Somatic Symptoms General” correlated with SDAI (r=0.30) and HAQ-DI (r=0.29). “Anxiety Somatic” correlated only with age (r=0.24), and other factors showed no correlation. Conclusion Higher percentage of RA patients reported “Somatic Symptoms” than “ Depressed mood “ as a factor of depression. These factors were mildly correlated with RA disease activity and HAQ-DI. Disclosure of Interests None declared
AB0861 Increased serum interleukin 8 levels in spondyloarthritis
Authors: L. Kharrat, M. Slouma, A. Tezeghdenti, E. Ghazouani, A. Abdennadher, K. Amri, Y. Mallat, L. Metoui, R. Dhahri, I. Gharsallah, B. Louzir
Journal: Annals of the Rheumatic Diseases (2022)

Background Physipathological mechanisms of spondyloarthritis (SA) are very complex. The role of the interleukin (IL)- 8, which is an angiogenic chemokine, has been suggested [1]. Objectives We aimed to evaluate the discriminative value of interleukin 8 in SA. Methods We conducted a cross-sectional study during two years (2019-2020) including 144 subjects divided into two groups: a group G1 that included 72 patients followed for spondyloarthritis meeting the Assessement of SpondyloArthritis international Society (ASAS) criteria and a group (G2) including 72 healthy controls. The two groups were matched by age and sex. IL-8 was measured for each participant using chemiluminescence. We performed a ROC analysis and computed the air under the curve (AUC) at IL-8 to assess the ability of this chemokine to diagnose SA and to distinguish between SA patients from healthy controls. Statistical analysis was performed using SPSS. Results We included 57 men and 15 females in each group. The mean age was 44.84 ± 13.42 years. In G1, the mean disease duration was 10.25 ±7.7 years. Axial and peripheral involvements were found in 85% of cases (n=65) and 50% of cases, respectively. The mean BASDAI and ASDAS-CRP were 3.21 ± 1.87 and 2.92 ±1.55, respectively. IL-8 was able to distinguish SA patients from healthy controls with a cutoff of 4.5 pg/mL. The AUC was good at 0.855 (p&lt;0.0001). The sensibility and the specificity were 92.8% and 81.6% (Figure 1). Figure 1. AUC at IL-8 between SA patients and healthy controls 0.855 (p&lt;0.0001) Conclusion Several studies have found that IL-8 was significantly higher in SA patients comparing to controls [2,3]. Our study showed that IL-8 could distinguish SA patients from controls with a cutoff of 4.5 pg/mL. This suggests that IL-8 could play a role in the pathophysiology of SA. References [1]König A, Krenn V, Gillitzer R, Glöckner J, Janssen E, Gohlke F, et al. Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis--an immunohistochemical and mRNA analysis. Rheumatol Int. 1997;17(4):159‑68. [2]Limón-Camacho L, Vargas-Rojas MI, Vázquez-Mellado J, Casasola-Vargas J, Moctezuma JF, Burgos-Vargas R, et al. In vivo peripheral blood proinflammatory T cells in patients with ankylosing spondylitis. J Rheumatol. avr 2012;39(4):830‑5. [3]Sonel B, Tutkak H, Düzgün N. Serum levels of IL-1beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies. Joint Bone Spine. 1 oct 2002;69(5):463‑7. Disclosure of Interests None declared
POS1417 INTEROSSEOUS TENDON INFLAMMATION IN THE HANDS: A NOVEL FEATURE OF DEVELOPING RHEUMATOID ARTHRITIS? RESULTS FROM A LARGE MRI STUDY IN CLINICALLY SUSPECT ARTHRALGIA
Authors: B. Van Dijk, H. W. Van Steenbergen, M. Reijnierse, S. Khidir, L. J. Wisse, M. C. Deruiter, A. Van der Helm-van Mil
Journal: Annals of the Rheumatic Diseases (2022)

Background Inflammation around the tendons of the hand interosseous muscles (interosseous tendon inflammation; ITI) on MRI was recently reported in rheumatoid arthritis (RA) patients and in ACPA-positive individuals with musculoskeletal symptoms. We therefore hypothesized that ITI is an early RA-feature that precedes clinical arthritis. Objectives To examine this we assessed the frequency of ITI in clinically suspect arthralgia (CSA) patients and compared this to the frequency in the general population. Additionally we investigated the relation between ITI and other locally inflamed tissues (synovitis/tenosynovitis/osteitis) in MCP-joins of CSA patients as well as the association with future arthritis development. Methods 667 consecutive patients presenting with CSA and 193 symptom-free controls from the general population underwent contrast-enhanced hand-MRI. MRIs were evaluated for ITI and for synovitis/tenosynovitis/osteitis, using the rheumatoid arthritis MRI scoring system (RAMRIS). CSA patients were followed for clinical arthritis development (median follow-up 25 months). Logistic and Cox-regression were used. ACPA-stratification was performed. To gain a better understanding of the anatomical relationships, 3D MRI-reconstruction of the interosseous and lumbrical muscles and tendons was performed in a patient with ITI. Results At presentation, 10% of CSA patients had ITI, compared to 1% of symptom-free controls (p&lt;0.001). ITI was more frequent in ACPA-positive than ACPA-negative CSA (27% versus 7%; p&lt;0.001). 72% of patients with ITI also had synovitis and/or tenosynovitis at the MCPs (37% synovitis; 7% tenosynovitis; 27% both synovitis and tenosynovitis). Also in multivariable analyses, adjusted for simultaneous presence of synovitis/tenosynovitis/osteitis, ITI was more likely if synovitis (OR 2.2 (95%CI 1.2-4.2)) or tenosynovitis (9.7 (5.5-17.0)) was present at MCPs. The 3D MRI-reconstruction indicated that ITI is continuous with MCP flexor tenosynovitis (Figure 1). CSA patients with ITI developed arthritis more frequent than those without (HR 4.5 (2.8-7.2)); this relation was stronger in ACPA-negative (3.9 (1.9-7.9)) than ACPA-positive CSA (1.8 (0.9-3.4)). Conclusion ITI is present in CSA and precedes clinical arthritis, suggesting that this peritendinous inflammation is an early RA-feature. Acknowledgements We thank G. Kracht for his assistance with preparing the example MR-image. Disclosure of Interests None declared
AB0326 EVALUATION OF BONE DENSITY PARAMETERS IN A COHORT OF PATIENTS AFFECTED BY RHEUMATOID ARTHRITIS: HOW THERAPY WITH GLUCOCORTICOIDS, METHOTREXATE AND bDMARDs CHANGES BONE MINERAL DENSITY, T-SCORE AND TRABECULAR BONE SCORE
Authors: A. Altomare, C. Rotondo, D. Cici, A. Trotta, A. Corrado, F. P. Cantatore
Journal: Annals of the Rheumatic Diseases (2022)

Background Osteoporosis (OP) can affect patients with Rheumatoid Arthritis (RA). This can be due to long-time use of glucocorticoids (GCS) or to the activation of proinflammatory pattern, via TNFα signalling, that leads to osteoclast (OC) activation with bone resorption. Objectives Aim of this study is to assess how therapy with GCS, methotrexate (MTX) and bDMARDs may change bone density parameters. Methods 66 RA patients were enrolled in this study. Bone Mineral Density (BMD), T-score of spine and femur, Trabecular Bone Score (TBS) and TBS T-score were evaluated at baseline and after 18 months of treatment with GCS, MTX, bDMARDs. Comparison among different patient groups were evaluated by ANOVA. P-value &lt; 0.05 was considered significative. Results At baseline, 66% of patients were female and 44% male, mean age was 62.2 (± 8.4) years, mean disease duration was 17.8 (± 11.2) years, 76% of patients were Rheumatoid Factor (RF) positive and 24% were RF negative, 71% were ACPA positive and 29% were ACPA negative, mean DAS-28 was 3.67 (± 1.34), mean L1-L4 BMD was 0.930 (± 0.175) g/cm 3 , mean neck’s femur BMD was 0.705 (± 0.102) g/cm 3 , mean L1-L4 T-score was -1.11 (± 1.54), mean neck’s femur T-Score was -1.17 (± 1.02), mean TBS was 1.239 (± 0.132) and mean TBS T-score was -2.36 (± 1.42). Among the entire population in study, 24.4% were affected by OP, 74.6% were in therapy with GCS, 57.8% with MTX and 16.6% were under OP treatment with bisphosphonate or teriparatide or denosumab. At baseline, 51.6% of patients started an TNFi treatment, 3.1% started an anti IL-6 treatment, 9.3% started an anti-CTLA4 treatment and 23.4% started a JAKi treatment. By ANOVA analysis, patients at baseline in therapy with MTX had mean L1-L4 BMD and L1-L4 T-score higher than those not in therapy with MTX, respectively 0.985 (± 0.184) g/cm 3 vs 0.866 (± 0.144) g/cm 3 (p &lt; 0.05) and -0.73 (± 1.70) vs – 1.62 (± 1.13) (p &lt; 0.05). At 18 months patients treated with MTX had higher L1-L4 T-score than those not in therapy with MTX, respectively -0.48 (± 1.68) vs – 1.68 (± 1.18) (p &lt; 0.05). Percentage variations in BMD, T-score, TBS and TBS T-score between baseline and 18-month endpoint were not significative; nevertheless, we observed a positive trend in lumbar and femur BMD percentage variations in patients treated with JAKi (2.89%), and in TBS percentage variations in patients in TNFi treatment (2.98%). Conclusion In this study we confirmed the high prevalence of OP in RA-patients. Therapy with MTX seems to prevent bone resorption, but it does not improve bone density parameters. Moreover, we observed a positive trend in JAKi-patients BMD and TNFi-patients TBS percentage variations, even though these data are not statistically significative due to the small sample. Disclosure of Interests None declared